Florida to expand Medicaid under health overhaul

TALLAHASSEE, Fla. (AP) -- Gov. Rick Scott announced plans Wednesday to expand Medicaid coverage to roughly 900,000 more people under the federal health overhaul, a surprise decision from the vocal critic of President Barack Obama's plan.

Scott said he will ask the Legislature to expand the program under a bill that would expire in three years, after which it would require renewed legislative support. He's the seventh Republican governor so far to propose expanding the taxpayer-funded health insurance program.

Scott said he would support the expansion as long as the federal government pays 100 percent of the increased costs, which is the deal offered to states by the Obama administration for the first three years. After that, the federal government said it would pay 90 percent of the cost for the additional enrollees.

The governor said he gained new perspective after his mother's death last year, calling his decision to support a key provision of the Affordable Care Act a "compassionate, common sense step forward," and not a "white flag of surrender to government-run healthcare."

"Before I ever dreamed of standing here today as governor of this great state, I was a strong advocate for better ways to improve healthcare than the government-run approach taken in the President's healthcare law. I believe in a different approach. But, regardless of what I — or anyone else — believes, a Supreme Court decision and a presidential election made the President's healthcare mandates the law of the land," Scott said at a news conference.

The governor said he still worries that the president's plan could "lead to less patient choice, worse care, and higher costs" but he can't "in good conscience deny the uninsured access to care." Scott stressed he won't simply deny new Medicaid recipients health insurance after the three years are up, but said he will spend that time measuring how the expansion impacts healthcare costs, quality and access.

Scott, a former CEO of the HCA hospital chain, entered politics in 2009 running national cable TV commercials criticizing the president's plan. Florida led the way in challenging the ACA in a lawsuit that went all the way to the Supreme Court. Scott also made the rounds on conservative talk shows repeatedly expressing concern that expanding Medicaid would put too much of a strain on Florida taxpayers.

At one point, he said the expansion would cost $26 billion over the next decade, but the state's health care agency slashed its estimate to $3 billion after backlash from lawmakers over how the initial figure was calculated. After Obama was re-elected, Scott toned down his rhetoric, signaling he wanted to work with federal health officials. He even flew to Washington to meet with Health and Human Services Secretary Kathleen Sebelius last month to discuss the expansion.

Florida lawmakers must still sign off on Scott's decision, and the Legislature doesn't meet until next month.

"I am personally skeptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability," Florida House Speaker Will Weatherford said.

Angry conservatives said Scott owes his support base an explanation.

"I am flabbergasted. This is a guy who, before he was a candidate for governor, started an organization to fight 'Obamacare' in the expansion of medical entitlements. This is a guy who said it will never happen on his watch. Well, here it is," said Slade O'Brien, Florida director of the conservative group Americans for Prosperity.

Scott's announcement came hours after federal health officials said they plan to approve the state's longstanding request to privatize its Medicaid program statewide if they agree to beef up transparency and accountability measures. He said that decision signaled that feds were willing to work with the state to give them the flexibility they need.

The other six GOP governors who plan to expand the program are the leaders of Michigan, Ohio, Arizona, New Mexico, Nevada and North Dakota. So far 21 states plus Washington, D.C., plan to expand their Medicaid programs under the health care law. Fourteen states have said they'll turn it down, although the debate is still going in several of them. Another 15 are weighing options.

Under the federal law, states were given the choice of whether to expand Medicaid to people whose incomes equal 138 percent of the federal poverty level — about $15,000 for an individual and $32,000 for a family of four.

Florida has one of the highest rates of uninsured residents in the country and some of the most stringent eligibility requirements. A family of three with income of $11,000 a year makes too much and single residents are not covered. The bulk of residents getting coverage under the Medicaid expansion will be childless adults.

The federal government's offer to cover most of the cost of expansion is much more generous than the roughly 50 percent matching rate that federal health officials currently pay for Medicaid. The state spends about $21 billion a year to cover roughly 3 million patients — about half are children.

Florida hospital officials have said the state would receive about $26 billion from the federal government to pay for Medicaid expansion over the next decade. That would be a huge boon to hospitals that are losing other federal funding sources for uninsured patients under the federal health law.

Advocates said Medicaid expansion will bring about 54,000 new jobs to the state and have a significant impact on Florida's tourism and hospitality industries.

Hospital executives have said the expansion will significantly reduce the amount of money spent covering uninsured patients by hospitals, insurers and taxpayers by allowing patients to get coordinated treatment whenever they need it instead of waiting to go to the emergency room.

The new Medicaid population will get coverage under the privatization proposal that federal and state health officials are still hammering out. The program would allow for-profit providers to determine the health care for Medicaid recipients with the goal of saving money and improving services

Federal officials are insisting on enhanced accountability measures by requiring the state to use real-time data that evaluates whether the program is actually improving patient care along the way as promised, not just at yearly benchmarks. The state must also hold regular meeting with health advocates, patients and insurers and hire an ombudsmen to oversee the portion of the program that involves tens of thousands of elderly, long-term care patients.

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